| Blue Phoenix Therapy Llc | |
|
1740 Grande Blvd Se Ste D-4 Rio Rancho NM 87124-1799 | |
| (505) 219-1028 | |
| Not Available |
| Full Name | Blue Phoenix Therapy Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1740 Grande Blvd Se Ste D-4, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Angela M Barela (OWNER) |
| Authorized Official Contact | 5052191028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Phoenix Therapy Llc 1740 Grande Blvd Se Ste D-4 Rio Rancho NM 87124-1799 Ph: (505) 219-1028 | Blue Phoenix Therapy Llc 1740 Grande Blvd Se Ste D-4 Rio Rancho NM 87124-1799 Ph: (505) 219-1028 |
| NPI Number | 1043960636 |
|---|---|
| Provider Enumeration Date | 03/25/2022 |
| Last Update Date | 08/29/2024 |
| Certification Date | 08/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043960636 | NPI | - | NPPES |
| 01354353 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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